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Motor recovery mechanism in a quadriplegic patient with locked-in syndrome.
[locked-in syndrome]
Locked-
in
syndrome
(
LIS
)
is
a
rare
neurologic
condition
caused
by
bilateral
pontine
lesions
.
Quadriplegia
is
one
of
the
most
serious
clinical
manifestations
in
patients
with
LIS
.
However
,
little
is
known
about
the
motor
recovery
mechanism
of
quadriplegia
in
patients
with
LIS
.
In
the
current
study
,
we
present
with
a
quadriplegic
patient
with
bilateral
pontine
infarcts
,
whose
motor
function
appeared
to
be
reorganized
into
the
peri-infarct
areas
of
the
infarcted
pons
,
as
demonstrated
by
diffusion
tensor
tractography
(
DTT
)
.
A
60
-
year
-old
was
diagnosed
as
LIS
due
to
bilateral
pontine
infarcts
6
years
ago
.
The
patient
presented
with
complete
paralysis
of
all
four
extremities
at
onset
.
After
slow
motor
recovery
,
the
patient
was
able
to
move
all
joint
muscles
against
gravity
and
demonstrated
some
fine
motor
activity
at
the
time
of
DTT
scanning
(
6
years
after
onset
)
.
Results
of
DTTs
for
the
corticospinal
tract
(
CST
)
in
both
hemispheres
showed
that
the
CSTs
originated
from
the
primary
motor
cortex
,
descended
along
the
known
CST
pathway
,
and
passed
through
lateral
areas
of
infarcts
in
the
pons
.
Therefore
,
motor
function
of
the
four
extremities
of
this
patient
appears
to
have
been
recovered
by
the
CST
,
which
passed
through
the
lateral
areas
to
the
pontine
infarcts
.